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Obamacare Outreach Cuts Expected to Undermine Exchanges

Cuts in Obamacare’s outreach funding for 2018 are expected to further undermine the
insurance exchanges by decreasing the population of younger, healthier people.

People who have health-care problems “will figure out a way to sign up,” but healthy
individuals aren’t likely to seek out coverage on their own, Jennifer Tolbert, director
of state health reform for the Kaiser Family Foundation, told Bloomberg BNA Sept.
1. “It is those young and healthy adults who are critical to making these markets
work that are less likely to sign up and need that extra outreach,” she said. The
Department of Health and Human Services
announced Aug. 31 that the advertising budget for the 2018 open enrollment period would be
cut from $100 million to $10 million, and funding for groups that assist people in
signing up would be cut 39 percent from the $62.5 million allocated for 2017.

The Trump administration announcement about the funding cuts comes the week before
the Senate Committee on Health, Education, Labor and Pensions begins hearings on ways
to stabilize the individual insurance markets for 2018. Those markets, which include
the Affordable Care Act exchanges, have been roiled by premium hikes and reduced insurance
participation as Republicans have unsuccessfully tried to repeal major parts of the
2010 law and as President Donald Trump has repeatedly Tweeted that the law will fail.

Grants Based on Meeting Goals

Grants for organizations in the Navigator program, created under the ACA to help people
choose health plans and enroll in the exchanges, will be based on their ability to
meet the enrollment goals they set for themselves during the previous year, according
to officials who spoke on an Aug. 31 telephone press briefing on condition that they
not be identified. For the 2017 open enrollment period, in which 12.2 million people
signed up, the Navigators enrolled 81,426 individuals, the HHS’s Centers for Medicare
& Medicaid Services said in a release.

But 17 navigators enrolled fewer than 100 people apiece, at an average cost of $5,000
per enrollee, and 78 percent of navigators failed to achieve their enrollment goals
during the previous year, the CMS said.

If a grantee achieved 100 percent or more of its enrollment goals for 2017, it will
receive the same funding as last year, the agency said. Grantees’ funding for 2018
will be based proportionally on how well their met their goals for 2018, CMS officials
said in the telephone press briefing.

There are 98 navigator organizations receiving grants in 2017, CMS officials said
in the telephone press briefing.

Moreover, during the 2017 open enrollment period that started last fall, the CMS spent
nearly double the amount that was spent in 2015, but first-time enrollees declined
by 42 percent and the number of people staying in the exchanges declined by about
500,000 individuals, the CMS said.

`Ineffective,’ HHS Says

“Obamacare’s Navigator program has been ineffective,” HHS press secretary Caitlin
Oakley said in an email Aug. 31. “A healthcare system that has caused premiums to
double and left nearly half of our counties with only one coverage option is not working.
The Trump Administration is determined to serve the American people instead of trying
to sell them a bad deal.”

ACA supporters and congressional Democrats were quick to call the funding cuts the
Trump administration’s attempt to “sabotage” the law.

The cuts are “outrageous,” Leslie Dach, director of the Protect Our Care Campaign,
said in a statement. “It’s one thing to tweet about your opposition to a law. It’s
another to undermine it, sabotage it and refuse to do your duty.”

Health insurers also signaled that outreach efforts shouldn’t be reduced.

“Effective education ensures that consumers understand their coverage options and
encourages broader participation of healthy individuals,” America’s Health Insurance
Plans spokeswoman Kristine Grow said in a statement. “Marketing, outreach, and education
are critical to ensure that all consumers are aware of the upcoming open enrollment
period, understand new timelines, and enroll by the deadline.”

Not Held to Goals Previously

In the Obama administration the navigator
groups were not held to meeting the enrollment estimates they made for the ACA qualified
health plans (QHPs), according to Shelli Quenga, director of programs at the Palmetto
Project, Inc., a navigator program for South Carolina. Palmetto, which is slated to
receive about $1.1 million for 2017, has enrolled people in about 1,900 QHPs in 2017,
while it has estimated it would enroll people in 2,200 for the year, she said.

Moreover, the goals must be set in June, before information is available the cost
of the plans is known, which insurance carriers will be in the exchanges, and how
many plans will be available, Quenga said. In the South Carolina exchange the only
carrier is BlueCross BlueShield of South Carolina.

Palmetto has projected enrolling about 1,200 people in QHPs during the 2018 open enrollment
period, but any cuts will reduce the number of people that can be helped, Quenga said.

Broader Responsibilities

In addition to helping people enroll in QHPs, the navigators are also responsible
for referring people who are eligible for Medicaid, assisting the health insurance
appeals, assisting with tax filings, and providing health insurance literacy, Quenga
said. In 2017 Palmetto fielded nearly 80,000 inquiries about coverage options over
the course of the current grant period, from Sept. 2, 2016, through Sept. 1, she said.

The 2018 open enrollment period was
shortened by the Trump administration from three months in previous years to six weeks, so
it lasts from Nov. 1 through Dec. 15. That makes it more important to have adequate
funding for people to assist enrollees, Tolbert said.

“Health insurance is complicated,” Tolbert said. “People don’t understand the concepts
of health insurance. Many are intimidated by the process of having to apply online,”
and they need assistance, especially if they run into problems about how to apply
or if they get an unfavorable determination for their eligibility to enroll through
the exchanges or to receive tax credit subsidies, she said.

To contact the reporter on this story: Sara Hansard in Washington at
shansard@bna.com

To contact the editor responsible for this story: Kendra Casey Plank at
kcasey@bna.com

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